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General NPI Number Information
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NPI Number | 1114916863
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Entity Type | Individual
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Provider Name | DOUGLAS J NESBITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 120 N EAGLE CREEK DR STE 460
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City | LEXINGTON
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State | KY
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Zip | 40509-1827
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Country | US
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Telephone | 859-263-7248
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Fax | 859-263-0714
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Provider Business Mailing Address
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Address Line | 120 N EAGLE CREEK DR STE 460
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City | LEXINGTON
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State | KY
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Zip | 40509-1827
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Country | US
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Telephone | 859-263-7248
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Fax | 859-263-0714
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 21624
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License Number State | KY
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